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NPI Code Detail

MEDICARE: TARA Y THOMAS MD

MEDICARE:   TARA Y THOMAS  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician60603MN

General Provider Information

NPI Number : 1427252329
Entity Type Code : Individual
Provider Name (Legal Business Name) : TARA Y THOMAS MD
Provider Business Mailing Address
First Line : 8170 33RD AVE S # MS 21110Q
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55425-4516
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2165 WHITE BEAR AVE N
Second Line :
City : MAPLEWOOD
State : MN
Zip : 55109-2707
Country : US
Telephone Number : 651-523-9800
Fax Number : 651-523-9801
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2007
Last Update Date : 08/23/2022

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Directions to “ TARA Y THOMAS MD” Practice Location

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